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How would you approach second isolated vaginal cuff recurrence in a young patient with FIGO IA Grade 2 endometrioid endometrial adenocarcinoma who received EBRT+ interstitial brachy for her initial recurrence?
The patient was initially observed after radical hysterectomy due to young age, FIGO IA grade 2 disease.
The patient had isolated, biopsy-proven vaginal cuff recurrence within one year, treated with 45 Gy/25 fractions to the pelvis followed by 6 Gy x 3 fractions of vaginal cuff HDR intracavitary brachytherapy.
The lesion resolved on clinical and radiographic exam, only to again recur within 2 yrs, with no distant disease.
Answer from: Radiation Oncologist at Community Practice
The dose delivered initially was on the lower side which may be a reason for recurrence. Normally we aim for 75 Gy EQ2 dose. This is our series for reradiation if exenteration is not an option Ling et al., PMID 30600093.
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Answer from: at Community Practice
It is always disappointing when patients recur, especially when they are at a young age. In this case, I would ideally have a PETCT scan to ensure there are no other sites of disease given that this is a second recurrence in a radiated field. If PETCT shows nothing else, then I would assess her for ...
Answer from: Radiation Oncologist at Academic Institution
Interstitial re-irradiation is an excellent option for this patient, and salvage (cure) is possible. I use permanent seeds (now Cs-131), which provide continuous low dose-rate radiation. This is safe, with very low complication rates, and often quite effective. Ultimate salvage rates are mostly infl...